Prof.

Essam Al-Abbasy
University of Alexandria
 Reaming

General Principles 

Sharp reamer 

Full speed rotation, but slow advancement 

Limited reaming 

Pass reamer limited (2-3 at most) number of times 

to determine canal size and encourage biology
 Reaming

?Why do we ream 
Increases blood flow and healing response
!Allows placement of larger nail....but
 Biology

Intramedullary Nailing is biologically

friendly
Minimally invasive
No direct exposure of fracture
Load-sharing device
 Allows insertion over a guidewire 

Reduction of intramedullary pressure 

while inserting the nail

 Newer designs
Early nail match shape
designs of bone with
were slight
straight mismatch
* *
 Ge omet ry
Nail

Longitudinal Curvature

Cannulation

Interlocking
To restore anatomy and
physiological functions
Bone is a remarkable composite with
outstanding self-repair capability,
recovering its form without permanent
scarring
Primary goal of fr. treatment is to
provide optimum mechanobiological
environment for each stage of fr.
healing.
Complete and detailed
preoperative plan
Selection of appropriate
implant is the first step
 Hard to tell what the right
reduction is, let alone to obtain
Use appropriate adjuncts to get
your reduction
Do not miss other Frs.
Allows lengthier and longer
diameter nails
 A.
Clover –leaf
cross
section
B.
Longitudina
l slot
Enhanced overall bone-implant
system stability

 the contact area

 mechanical linkage
between nail and bone
An intra-medullary implant can
be successfully performed with
the utilization of fr. reduction
and stable fixation.
 Exploring the proximal femur
is the worst. Tip of greater
trochanter is not collinear with
axis of medullary canal.
The procedure of Nancy nail is
coming the standard of care
when used on the appropriate
patients.
Short hospital stay

V. good functional and cosmetic

results

Less coast
.In retrograde nail in diaphyseal fr
Trochanteric entry
Forearm fr. in children are
common
Closed reduction GA+ casting

Wires and casting

Closed or miniopen + intramedullary

fixation
Open reduction & internal fixation
Nancy nails (elastic stable
intramedullary nail) fixation  a
modality of treatment for fractures of
shaft BB of forearms
General anaesthesia + image +
pneumatic tourniquet
Flexible intramedullary nailing of
pediatric humeral fractures
Most proximal & diaphyseal
pediatric humeral fractures

Closed means
Certain patient factors or fr.
characteristics

Surgical stabilization
Use of titanium elastic nails in
adults diaphyseal humerus
 Closed anti-grade

Safe & reliable

In upper humeral shaft in adults
 Treatment of humeral shaft fr.
in adults remains a challenging
issue
Fr. of proximal humerus and humeral
shaft are always a matter of intensive
discussion

Conservative or operative
 Treatment of distal tibial fr. with
intramedullary implant can be
complex and challenging but it does
not have to be stressful or difficult
 In all cases

Maintenance of reduction
until union
 Last points

Development of fine biocompatible 

materials  capable of reducing

disproportion between living tissue and
.implant
 Whether or not to remove the nails after
fr. healing for adults and children.

Future research should aim at better

understanding the ideal
mechanobiological environment for each
stage of fr. healing.